Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 2767 | KS |
NPI | 1427584929 |
---|---|
Provider Name | Laura Gawecki |
First Address | Leavenworth, KS 66048-4435 |
Second Address | Leavenworth, KS 66048-4435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2017 |
Last Update Date | 04/05/2017 |